Left ventricular dysfunction in lethal severe brain injury: impact of transesophageal echocardiography on patient management

Abstract

Abstract

Objective. To evaluate the impact of transesophageal echocardiographic (TEE) studies on further patient management and incidence and degree of left ventricular (LV) dysfunction in patients with lethal severe brain injury.

Design and setting. Retrospective, clinical study in two surgical intensive care units in a university hospital.

Patients. In 51 patients with severe brain injury ultimately leading to brain death, the results of TEE studies were reviewed for evidence of newly developed LV dysfunction (i.e., regional wall motion abnormalities) and its impact on patient management.

Measurements and results. Seven patients (13.7%) had a diminished LV function global (fractional area change <50%). Four of these patients (7.8%) exhibited a severely reduced LV function (fractional area change <35%). Regional wall motion abnormalities and preserved global function were found in eight patients (15.7%). Patient management was altered in all patients with diminished LV function: implementation of advanced hemodynamic monitoring (n=5), institution or adjustment of inotropes and adjustment of fluid management (n=7). In patients exhibiting a severely reduced LV function and deteriorating cardiovascular status, brain death diagnosis was established by one clinical examination in conjunction with laboratory tests, thus shortening the interval required for brain death diagnosis by about 12 h.

Conclusions. Severe LV dysfunction occurred in about 8% of our patients with severe brain injury ultimately leading to brain death. TEE may be helpful in guiding cardiovascular resuscitation ultimately leading to improved organ procurement rates.